Abstract:
Topics include: The early warning signs of type 2 diabetes that are often missed, the fact about beta cell loss, and why “reversal” is a misleading term compared with clinically defined remission. She also clarifies the differences between Diabetes mellitus and Diabetes insipidus, the limitations of relying solely on Continuous Glucose Monitors (CGMs), and the education gaps that continue to hold back professionals across nutrition, fitness, and health.
Importantly, Dr de la Vega highlights why personalisation is essential in diabetes management and introduces the upcoming Diabetes Health Continuing Education Diploma, designed to equip practitioners with the evidence-based skills to better support clients. This Q&A is an essential read for nutritionists, health coaches, personal trainers, and medical professionals seeking to deepen their knowledge and confidently address the growing diabetes epidemic.
Below are all the questions answered (full transcript):
Dr Michelle de la Vega: As of 2024, there are approximately 589 million adults living with diabetes.
Let me repeat that number, 589 million adults. It’s about 11% of the adult population who have diabetes.
And surprisingly, about 40% may actually be unaware that they’re living with this condition, which means that they’re not balancing their blood sugars, and they might have other complications, and so on. And this number is actually expected to increase.
By the year 2050, it’s going to be 853 million individuals, adults living with diabetes. So we are looking at a chronic condition that right now already affects more than 1 in 10 individuals.
Dr Michelle de la Vega: There’s a lot going on in our body cells that we really don’t pay attention to. We’re breathing without thinking.
We typically walk without thinking. The same thing is happening in the progression of diabetes, especially in the case of type 2. There are factors which are influencing risk happening in the background that we’re not paying attention to, that we don’t notice because they may not be symptoms yet.
For example, chronic low-grade inflammation, insulin resistance, glucose intolerance, hyperinsulinemia, and poor functioning of our pancreatic beta cells. These all might be occurring in the background within ourselves, within our bodies. But there are no symptoms for it, which means that individuals may actually have prediabetes, which is a state where blood glucose levels are higher than normal, but not quite at the level of type 2 diabetes, and they might not even know about it.
And this might be for five, 10 years, someone might have these changes in the body, might have what we consider prediabetes, and they don’t even know about it.
Part of the issue with this is that we don’t screen for it early enough. Screening comes when symptoms occur, which may mean that screening may actually already happen when someone has type 2 diabetes and not during this prediabetes stage, where we may actually be able to greatly reduce the risk of developing type 2 diabetes.
Dr Michelle de la Vega: There’s some truth to this, but there’s also a little bit of misinformation in there. So it might not be that beta cells are actually gone, but it might actually be that we’re losing function of beta cells, which is an important distinction between the two.
And why is the distinction so important? Well, it means that if there’s function loss, we may be able to partially restore function again, which leads to this idea of almost reversing diabetes.
We’ve all heard someone say, “I reversed my diabetes,” or if they’re diagnosed, “I’m going to reverse my diabetes.” This suggests that we can go back to a pre-disease state, which isn’t always accurate.
So, what we now aim for is remission. And what is remission? It’s really a return of HbA1c levels to less than 6.5%. And it needs to be that way for at least three months in the absence of any diabetes medication, for example, insulin. And when we talk about remission, it is for type 2 diabetes only. It’s not for type 1 diabetes, and it’s important to make that distinction.
And unfortunately, even though this remission is possible, it’s pretty rare. Only about 3% of those with type 2 diabetes achieve remission. And it takes years to get to this point. It’s not an overnight of “I was diagnosed with type 2 diabetes today, and tomorrow I’m going to go into remission.” It actually takes years to go back to the state of HbA1c levels lower than 6.5. So there are a lot of factors that sort of go into this.
If we think of weight loss, glycemic control, blood level, glucose levels, blood glucose levels, if we think of lifestyle changes, behaviour change is really hard. And in a lot of cases, support systems are missing. So we really need to look at this as sort of a long-term thing.
So it’s really understanding how to use a continuous glucose monitor, understanding how the data is interpreted, understanding what we can do with this information, what we can’t do with this information, who it helps, and not to completely rely on it.
Let me give you an example:
Plus, a CGM isn't for everyone.
Dr Michelle de la Vega: So, we’ve been talking so far about the science of diabetes. Let’s jump in and switch gears a little bit and go into some of the gaps that might be out there for professionals… nutrition professional, health professionals, fitness professionals, that may be either have diabetes themselves or working with those that have diabetes, that have been diagnosed with either type 1, type 2, GDM, or these other types of diabetes that we mentioned previously. And there are unfortunately a lot of gaps.
Individuals generally know the basics of diabetes, but not what to do in a lot of situations.
Take for example, a nutrition professional, someone with type 2 diabetes comes to them and they were just diagnosed with type 2 diabetes, but they’re balancing their blood glucose levels. They’re not eating a lot of sweets. They might not be overweight completely, or they might not be obese, but maybe they have a little bit of extra body fat, but not extreme obesity. So, what’s going on? What could possibly be contributing to their changing blood glucose?
What other factors can they look at?
There are a lot of risks that increase in individuals who are actually not balancing their blood glucose levels, which means that it’s really important for an individual who’s diagnosed with type 1, with prediabetes, with type 2, with GDM, to speak with someone who is an expert.
It’s important for an individual to really understand what’s going on, and for nutritional professionals to sort of help them and support them and get them to that point. And it really takes multiple individuals to help with this. It’s not just a nutrition professional, for example, or it’s not just a medical professional. In order to create a good self-care plan for an individual with diabetes, there almost has to be a team.
A medical professional that an individual may talk to every three to six months for blood work. Great, those bloodworks are extremely important to know where an individual is at. But what happens in between those points? In some cases, an individual may be sent home from that medical professional and not actually have any support, which can lead to complications. It can lead to those non-balanced blood glucose levels. And that can cause a lot of harm to the individual if they don’t have that follow-up support.
Individuals who do, between those three-month appointments with their medical professional, or a six-month appointment with a medical professional, do you have someone to help them create that self-care plan and help them balance those blood sugar levels can be super important.
Dr Michelle de la Vega: Not everyone with type 2 diabetes needs the same care plan. Not everyone with prediabetes needs the same care plan. It’s different for each individual. Every person has a different story.
Someone might be overweight. Another person might not be. Another person might have an addiction to soda. Someone else may like their chips. And there are all these different things that we sort of need to consider and look at when we create those self-care plans to support an individual. So we really do need to create personalised plans for an individual with diabetes.
And not just, okay, here’s a meal plan that focuses on low GI foods. “I know that you don’t like a bunch of these, but that really doesn’t matter. You just need to eat them because they’re low GI.” And really personalise it for the individual. “Okay, fine. You don’t like these low-GI foods. How about these ones? Let’s try this one. Or you don’t like this, that it was cooked this way. Let’s learn how to cook it a different way.” Plans really need to be personalised for an individual, whether they have type 1, type 2, prediabetes, GDM, or all these different types. And we really need to support an individual who’s diagnosed with that.
Dr Michelle de la Vega: Our upcoming Diabetes Health Continued Education Diploma was built to address these issues, to address these areas where personalisation is needed, where we need to focus. And while they all fall under this umbrella of diabetes mellitus, the different types are different, and we need to know how to personalise them so that we can best help that individual as much as possible.
It’s not a, oh, this is interesting. I’d like to know that. It’s really a shift in how we provide information to health professionals for the future in order to decrease the risk of developing and help manage those who already have it.
It’s not a, oh, this is interesting. I like to know that. It’s really a shift in how we provide information to health professionals for the future in order to decrease the risk of developing and help manage those who already have it.
So what is diabetes? What’s going on in the body? Continuing to the lifestyle factors that can be under our control to help balance those blood glucose levels so that we can live a healthier life, have a higher quality of life, which is lessened with complications and symptoms.
There are a lot of individuals who need to work together to create a self-care plan for an individual. So clinical nutritionists, health coaches, and fitness professionals – they’re all really needed in the support and post-diagnosis care.
The system, unfortunately, is overwhelmed. Medical doctors typically only have a few minutes to discuss post-care with an individual at their diagnosis or after diagnosis. So they need to refer to someone else.
We really need to get the know-how and the knowledge now and help reduce that risk, because that’s key right from the beginning. And if they actually do get diagnosed, you know what? It doesn’t just have to be medical personnel who take all of the weight. And it shouldn’t be. Yes, they’re important. A medical professional is crucial. But we can also have nutritionists, nutrition professionals, health coaches, fitness professionals, who help support after that diagnosis. It’s really important to have a team with diabetes. So, our upcoming Diabetes Health Continued Education Diploma was really built to address these blind spots.
It's not a course that is nice to know. It's crucial to know.
Wrapping up…
And you know what? I have a great surprise for you – I will be interviewing and bringing to you a couple of these interviews. So, for example, I’m going to be speaking with an athlete who is diagnosed with type 2 diabetes, and he’s going to share his story about his diagnosis, about problems that he’s had, and about the successes that he’s had as well. So I’m really looking forward to that chat with him.
